Patient Experience Research Articles

Avoiding sliding doors: small changes, big difference in multiple sclerosis and neurogenic bladder and bowel

The aim of this article is to illustrate the experienced and optimal patient journeys of people with multiple sclerosis. A review of research published in the British Journal of Neuroscience Nursing in 2024 was conducted to build on the insights and provide guidance around each part of the patient journey, from diagnosis to care. A composite patient journey was created based on the experiences of the MS patients interviewed as part of the ALERT study. Many people with multiple sclerosis experience delayed diagnosis and management of bladder and bowel dysfunction, leading to significant physical and psychosocial consequences. The composite patient journey showed common clinical touchpoints where care was sub-optimal. There was a lack of early discussions about bladder and bowel issues, insufficient patient education and missed opportunities for intervention. Early diagnosis, patient education and integrated care pathways are essential for managing neurogenic bladder and bowel dysfunction in people with multiple sclerosis. By addressing these issues proactively, healthcare providers can improve patient outcomes and quality of life. Policy initiatives should focus on increasing awareness, education and developing clinical guidelines to support effective bladder and bowel management. Integration of care services reduces inequities and improves wellbeing.

OPTIMUM DESIGN OF INTENSIVE CARE UNIT- AN EVIDENCE- BASED HEALING ENVIRONMENT

Successfully designing a new ICU requires clarity of vision and purpose and the recognition that the patient room is the core of the ICU experience for patients, staff, and visitors. The ICU canbe conceptualised into three components: the patient room, central areas, and universal support services. Each patient room should be designed for single patient use and be similarly configured and equipped. The design of the room should focus upon functionality, ease of use, healing, safety, infection control, communications, and connectivity. All aspects of the room, including itsinfrastructure; zones for work, care, and visiting; environment, medical devices, and approaches to privacy; logistics; and waste management, are important elements in the design process. Since most medical devices used at the ICU bedside are really sophisticated equipments, the ICU needs to be capable of supporting the full scope of medical informatics. The patient rooms, the central ICU areas (central stations, corridors, supply rooms, pharmacy, laboratory, staff lounge, visitor waiting room,) and the universal support services (infection prevention, finishings & and flooring, staff communications, signage & wayfinding, security and fire & safety) work best when fully interwoven. This coordination helps establish efficient and safe patient throughput and care and fosters physical and social cohesiveness within the ICU. Synchronisation of the universal support services in the ICU with the hospital’s existing systems maintains unity of purpose and continuity across the enterprise and avoids unnecessary duplication of efforts.

Re-Expansion Pulmonary Edema Post-Pneumothorax

Vacuum pulmonary edema is a rare yet potentially serious complication, associated with a mortality rate of 15 to 20%. It typically arises as an uncommon consequence of draining a pneumothorax or pleural effusion, presenting with symptoms such as cough, chest pain, and hypoxemia. In severe cases, it can lead to shock and even death, with symptoms generally appearing within 24 hours following thoracentesis. Management is primarily supportive, involving treatments that range from oxygen supplementation to both non-invasive and invasive ventilation techniques. Preventive measures include using low negative pressure (< −20 cm H2O) during suction in thoracentesis and avoiding excessive pleural fluid drainage if the patient experiences chest discomfort. We present a case of a patient who developed vacuum pulmonary edema subsequent to the drainage of a pneumothorax.

Understanding the relative impact of ethnicity and sex on patient experience in cancer care.

247 Background: Patient experience is a key indicator of healthcare quality and outcomes. Research suggests that patient ethnicity and sex have a significant impact on patient experience scores. Therefore, our hospital created a process for continuously monitoring patient experience scores stratified by patient demographic data. In 2021, this process caught what appeared to be a significant drop in some areas of patient experience for non-white female inpatients. This drop prompted an investigation that attempted to better understand the relative impact of ethnicity and sex on patient experience at our hospital. Methods: We conducted a cross-sectional study using 13,560 Press Ganey inpatient experience surveys collected from 11,435 unique patients between 2021 and 2023 at Memorial Sloan Kettering Cancer Center. This investigation analyzed the responses to “likelihood of recommending this hospital to others” using a ordinal logistic regression model including patient ethnicity, sex, language, age, expected mortality on admission, admitting department, insurance, marital status, and length of stay observed to expected ratio. Results: Asian (odds ratio [OR] 0.51, 95% confidence interval [CI] (-0.86,-0.47), p=1.98e-11), female (odds ratio [OR] 0.76, 95% confidence interval [CI] (-0.38,-0.15), p=2.76e-06), and patients admitted to emergency departments female (odds ratio [OR] 0.59, 95% confidence interval [CI] (-0.73,-0.30), p=1.65e-06) reported lower scores than white, male, and patients admitted to medicine. Differences associated with marital status, patient insurance, and patient primary language were insignificant. The largest impact on patient experience was the patient’s expected mortality (odds ratio [OR] 0.30, 95% confidence interval [CI] (-2.20,-0.19), p=1.98e-02). Patients with higher expected mortality were much more likely to give low scores. Non-white patients were also more likely to have high expected mortality when compared to their white counterparts (p = 1.90e-24). Conclusions: Our study suggests that while a patient’s expected mortality on admission has the largest impact on patient experience scores. There are also significant differences in patient experience scores based on ethnicity and sex, but they are relatively small in magnitude. The data suggests that focusing on the intersection of high expected mortality and female patients could be an effective method for improving healthcare quality and outcomes. We recommend additional exploration of end of life care and its interactions with patient experience to better understand optimal methods and times for process improvement projects.

The relationship between patient-reported experience and patient-reported outcomes in patients with cancer.

248 Background: Measures of patient experience (PEX) and patient-reported outcomes (PRO) are used by health systems across the US to improve care delivery and quality of life, respectively. Despite their widespread use, little is known regarding the relationship between these two types of patient-generated data. From 2018 to 2023, we conducted a pragmatic type-II hybrid effectiveness/implementation study of an electronic health record (EHR)-embedded symptom management program (eSyM) across six diverse cancer centers. This project focused on patients who started chemotherapy (CHEMO) or had surgery (SURG) for a suspected or confirmed gastrointestinal, gynecologic, or thoracic malignancy. Methods: We conducted a cross-sectional study of adults who were eligible for either the control or intervention arm of the eSyM study to determine if patients who reported having an inferior care-team experience were more likely to report having worse symptoms. Participants completed a one-time survey via REDCap that included elements from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and the Patient-Reported Outcomes Measurement Information System (PROMIS). Analyses determined the extent to which PEX measures were associated with PRO measures by evaluating differences in mean PROMIS scores for those who rated their PEX highly vs. not highly. Results: In total, 1419 respondents reported having cancer for which they received care at a participating center: median age 66, 63% female, 5% black, 13% disabled, 66% married/partnered, 23% high school or less education, 22% somewhat-extreme difficulty paying bills. For both CHEMO and SURG patients, 82% rated their overall cancer care-team experience highly (top box score of 9-10). Compared to patients who did not rate their care-team experience highly, those who did reported better scores for depression, fatigue, anxiety, pain interference, physical function, and self-efficacy (Table). PROMIS values differed for other CAHPS measures too. Conclusions: Among patients receiving routine cancer care, there was a significant association between PEX and multiple PROs. Further investigation of the nature and strength of the association between PEX and PRO measures is warranted. If confirmed, this association could lead to the development of interventions that impact both patient satisfaction and quality of life. Clinical trial information: NCT03850912 . Mean difference in PROMIS scores for patients who rated their care-team experience highly versus not highly (P from two-sample T-test). CHEMO (N=889) SURG (N=530) Mean Diff 95%CI P value Mean Diff 95%CI P value Depression -2.7 -4.3, -1.1 0.001 -3.3 -5.3, -1.4 <0.001 Anxiety -3.7 -5.4, -1.9 <0.001 -3.6 -5.7, -1.5 <0.001 Fatigue -2.3 -4.0, -0.5 0.011 -4.5 -6.8, -2.2 <0.001 Pain interference -3.6 -5.3, -1.9 <0.001 -4.7 -6.7, -2.7 <0.001 Physical function 1.6 0.1, 3.1 0.042 3.5 1.4, 5.6 0.001 Self-efficacy 3.9 2.6, 5.2 <0.001 6.4 4.6, 8.1 <0.001

In Their Own Words: Patient Narratives of Breast Cancer Surgery and Reconstruction.

Breast cancer's global burden prompts a comprehensive understanding of patient experiences surrounding surgical interventions. Social media platforms serve as a new potential avenue for analysis, reflecting patients' coping mechanisms and support-seeking behaviors. This study's objective is to further understand patient experiences regarding breast cancer interventions via social media to improve physician-patient dialogue. A cross-sectional study was conducted of Instagram and TikTok posts surrounding breast cancer surgeries using procedure-related hashtags. Content was categorized to prevalent themes related to Breast-Q foci and was subsequently analyzed. Data from 1,028 individuals were analyzed. Posts encompassed double mastectomy (39%), single mastectomy (22%), and combineddeep inferior epigastric perforator flap, latissimus dorsi flap, and transverse rectus abdominis muscle flapreconstruction (39%). Frequently identified themes included 'Raising Awareness' (86.87%), 'Spreading Positivity' (53.11%), 'Resiliency' (31.03%), 'Online Support' (24.61%), 'Update of Appearance' (20.82%), 'Recovery/Rehab' (19.94%), and 'Scientific Explanation' (19.75%). Instagram posts more likely encompassed positivity (p < 0.001), resiliency (p = 0.001), and mental health (p = 0.011). TikTok posts more likely (p = 0.001) discussed scientific explanations, decision-making, and symptoms (p < 0.001). Preoperative posts more likely (p < 0.001) surrounded scientific explanations, decision-making, and fear. Postoperative posts more likely (p < 0.001) highlighted appearance updates, recovery/rehab, and positivity (p = 0.012). Experiences with mastectomy and reconstruction differed: recovery/rehab (p < 0.001), scientific explanations (p = 0.015), treatment process (p = 0.003), range of motion (p < 0.001), self-esteem (p = 0.017), and wound management (p = 0.008). Concerns of patients online reflect Breast-Q measures. Understanding these nuanced patient discussions can provide novel insights for providers. Tailoring interactions through these insights may facilitate enhanced support, discussions, and experiences throughout the treatment journey. Main Points Social media offers a unique insight into personal patient experiences Online breast surgery patient perspectives reflect Breast-Q measures Outlooks from shared online posts may facilitate physician-patient dialogue LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Exploring patient perspective: using narrative DIPEx interviews and the ICF model for interprofessional learning.

The International Classification of Functioning, Disability, and Health (ICF) has been widely adopted in academic health profession education and is part of bachelor curricula since its introduction by the WHO in 2001. In this context, interprofessional exchange among health professionals from a biopsychosocial perspective has become increasingly important and is now a key part of bachelor's program curricula to learn with, about, and from each other regarding students' curiosity about interprofessional collaboration (IPC). This pilot study describes initial teaching experiences within an interprofessional elective module for health professions focused on patient-centeredness. It uses the ICF model to exemplify interprofessional exchange based on real patient experiences from the "DIPEx" database, which stands for "Database of Individual Patients' Experiences." Bachelor students from four healthcare professions learned in small interprofessional groups and selected case-related content from excerpts of real patient narratives from qualitative interviews in the DIPEx database. In a peer-to-peer process, students structured, analyzed, and reflected on selected patient experiences and presented their findings using the ICF model. Develop a shared understanding of the case from a biopsychosocial perspective using the ICF model to communicate and reflect on patient-centeredness in interprofessional groups for a common care strategy rooted in patient-centeredness. This study illustrates how the shared analysis of a patient's experience of illness can lead to different perspectives on professional concepts for practice. The ICF model serves as a guiding structure and analysis tool. The core of the IPC, patient-centeredness, becomes the focus of the collaborative actions of the health professions.

Improving language access in pharmacy at a comprehensive cancer center.

176 Background: Dana-Farber Cancer Institute (DFCI) conducted quantitative analyses of patient satisfaction survey data, stratified by patient demographics, to understand where gaps in experience exist. Results demonstrated differences among certain demographic groups, directing us to explore patient experiences qualitatively. DFCI conducted focus groups with diverse patient groups to identify improvement opportunities. Twelve virtual focus groups were conducted with adult cancer patients with Limited English Proficiency (LEP) and/or from historically marginalized populations (n=34). One additional focus group was conducted with DFCI patient-facing staff (n=15). Focus group participants identified the need for providing timely and informative ways to telephonically communicate with pharmacy staff in their preferred language. Patients with LEP indicated they felt less valued/heard due to the language barrier and were subject to longer call wait times because they needed an interpreter to speak with pharmacy staff. Methods: A multidisciplinary team was assembled to assess the current state of telephonic pharmacy language access and to redesign the workflows of the pharmacy phone lines. By June 2024, DFCI aims to increase the number of languages in which patients can engage with pharmacy services from 1 to 5 by expanding telephone workflows to include multi-lingual prompts and automatic connection to an interpreter. Process metrics include rate of patients communicating telephonically with DFCI pharmacies in their preferred language and average time for a non-English speaking patient to connect with an interpreter. To assess patient experience, DFCI is administering a satisfaction survey (both pre- and post-go-live of the phone line redesign) to patients with LEP who have used the pharmacy phone lines. This will assess whether the change has resulted in improvement. Results: Post go-live (June 2024) results will include the process and patient experience metrics described above. Conclusions: DFCI is among the first in the country to analyze its patient satisfaction data by demographic characteristics; to convene focus groups (informed by patient satisfaction demographic analysis) with historically marginalized and/or LEP populations; and to carry out an improvement effort (leveraging quantitative and qualitative data) to redesign pharmacy phone lines to be more inclusive. The pharmacy phone line redesign is critical to providing an equitable and satisfying experience for our patients with LEP.

Exploring the decision-making experience of elderly diabetes patients regarding their health-seeking behaviour: a descriptive qualitative study

BackgroundDiabetes has emerged as a critical global public health issue. The burden of diabetes is escalating in developing countries, including China. For individuals with diabetes, making informed and rational decisions...

Exploring the Well-being Experiences of Patients Following Heart Valve Replacement Surgery through the Biopsychosocial-spiritual Model: A Qualitative Content Analysis.

Heart valve replacement (HVR) surgery represents a significant life event that can potentially impact the well-being (WB) of patients; however, there is a shortage of research on the understanding of WB in HVR patients. This study aims to elucidate the WB experiences of patients who have undergone HVR surgery. A qualitative directed content analysis approach was employed, focusing on patients who had undergone HVR surgery at hospitals affiliated with Mashhad University of Medical Sciences in Iran from March 2021 to June 2022. Data collection involved conducting 23 face-to-face, semi-structured, in-depth interviews with HVR patients until data saturation was reached. Data analysis was performed using the Elo and Kyngäs approach in MAXQDA software version 10. The analysis revealed 11 generic categories based on the Biopsychosocial-Spiritual (BPSS) model, encompassing the WB experiences of HVR patients. These categories included physical improvements, facilitated treatment compliance, personal and environmental mastery, optimism in life, resilience, healing therapeutic communication of medical staff, a positive supportive atmosphere, job and financial assurance, faith in a higher power, optimism regarding a purposeful future, and gratitude mixed with generosity. The findings of the current study revealed that the experience of WB in HVR patients was influenced by various conditions. By recognizing these conditions, healthcare providers can develop targeted interventions to improve the WB experience in these patients. Also, the findings provide a foundation for future research on WB in medical contexts.

Relationships between stigma, coping styles, self-care and post-traumatic growth among colorectal cancer patients with permanent enterostomy: A cross-sectional study

Post-traumatic growth is a positive outcome that helps buffer the adverse experiences in patients after traumatic enterostomy surgery. This study aimed to investigate post-traumatic growth among patients with permanent enterostomy and explore the relationships between stigma, coping styles, self-care, and post-traumatic growth. Convenience sampling was used to enroll patients who underwent a permanent enterostomy. A total of 305 eligible participants completed self-reported questionnaires on stigma, coping styles, self-care, and post-traumatic growth, respectively. Positive coping style and self-care were positively correlated with post-traumatic growth (p < 0.001), whereas, negative coping style and stigma were negatively correlated with post-traumatic growth (p < 0.001). Serial mediation models revealed that stigma could significantly predict post-traumatic growth through five indirect pathways: (1) positive coping (effect = -0.129); (2) negative coping (effect = -0.051); (3) self-care (effect = -0.115); (4) chain mediation of positive coping and self-care (effect = -0.049); (5) chain mediation of negative coping and self-care (effect = -0.019), accounting for 17.6%, 6.9%, 15.6%, 6.7%, and 2.6% of the total effect, respectively. Our findings demonstrated that coping styles and self-care acted as separate and sequential mediators affecting the relationship between stigma and post-traumatic growth in patients who underwent enterostomy. Therefore, interventional strategies targeting coping styles and self-care may provide synergistic benefits to patients with permanent enterostomy by enhancing their post-traumatic growth.

Thoracic MRI in pleural infection – a feasibility study from patients’ and radiographers’ perspectives

BackgroundPleural infections present significant clinical challenges, particularly in elderly or immunosuppressed patients, leading to prolonged hospital stay, high morbidity and high mortality. While CT and X-ray are standard imaging modalities, MRI's potential remain unexplored due to historical limitations in scan duration and patient discomfort. Advances in MRI technology, however, may enable its broader use in thoracic imaging. The study aimed to explore the feasibility of thoracic MRI from the radiographers’ and patients’ perspectives. MethodsA prospective feasibility study was conducted involving thirteen patients with pleural infections who underwent thoracic MRI as an add-on within 48 hours of the conventional contrast-enhanced chest CT. Feasibility was assessed on technical success, and scan duration. Patients and radiographers experiences were evaluated through questionnaires and qualitative comments. ResultsTechnical success was high as all thirteen patients completed the scans. The mean in-room time was 30.7±5.5 minutes and the mean scan time was 23±5.4 minutes. Radiographers reported the MRI scans as feasible with few patients requiring breaks or assistance. Most patients found the MRI experience manageable though two reported difficulties with breath-hold instructions. No patients were challenged by lying in supine position and no patients felt very anxious. No significant movement- or breathing artefacts were identified on MRI. ConclusionThoracic MRI is feasible with high technical success, acceptable scan time, and good patient experience in patients with pleural infections offering potential as a radiation-free imaging modality. Furthermore, compared to CT, the use of MRI showed potential advantages in identifying pleural effusion septations.

Bringing Patients Out of The Gloom: Examining The Effects of Patient Power and Affect Labeling on Emotional Experience Reflected in Emotional Judgement

ObjectiveNegative emotions are common among patients in medical settings. It is important to investigate impacts of patient power and affect labeling on emotional experience in patients. MethodsBehavioral judgments and event-related potentials (ERPs) were recorded while participants with high or low patient power made emotional judgments (positive, negative) about neutral faces, as well as investigating how affect labeling (affect labeling, viewing) influenced emotional judgments about neutral faces in participants with low patient power. ResultsIndividuals with low patient power made more and faster negative emotion judgements. A larger late positive component (LPC) amplitude was found in negative emotion judgments for individuals with low patient power, a component related to allocation of attentional resources to motivationally salient stimuli. Affect labeling elicit less and slower negative emotion judgments in individuals with low patient power. ConclusionsThese results suggest that low patient power triggers negative emotion, which can be reduced by affect labeling. Practice implicationsThe current findings provide valuable insights into reducing negative emotions in patients, fostering promising targets for training for medical professionals and education for patients aiming to ensure more humanistic and higher-quality care delivery.

Experience of Patients and Caregivers During the Predialysis Period: A Thematic Analysis

Experience of Patients and Caregivers During the Predialysis Period: A Thematic Analysis

Embracing technological innovations in healthcare: An evaluation of a newly implemented dietetic telehealth service and strategies to improve technology acceptance and experience of patients and staff in Hong kong

Embracing technological innovations in healthcare: An evaluation of a newly implemented dietetic telehealth service and strategies to improve technology acceptance and experience of patients and staff in Hong kong

Perspective and experience of patients on nutritional care and education across the cancer journey

Perspective and experience of patients on nutritional care and education across the cancer journey

Patients' experiences with the application of medical adhesives to the skin: a qualitative systematic review.

Medical adhesives provide securement of medical devices, facilitate skin protection and allow non-invasive monitoring. Application and removal of medical adhesives can result in pain, dermatitis, trauma or other skin lesions. Understanding patients' experiences when subjected to medical adhesives will contribute to the improvement of clinical routines and the development and improvement of new adhesive technologies. A qualitative systematic review was conducted to identify patients' experiences with the application of medical adhesives to the skin. Qualitative systematic review. CINAHL, EMBASE, MEDLINE and PsycINFO were systematically searched for records published between January 2012 and March 2024. Reference lists of systematic reviews and included articles were reviewed. Studies published in Danish, Dutch, English, German, Norwegian and Swedish that collected qualitative data on the experience of patients with the application of medical adhesives to the skin were considered. There were no restrictions regarding age, gender or setting. Study selection, data extraction and quality appraisal were independently conducted by two reviewers. The methodological quality of the studies under consideration was assessed using the Joanna Briggs Institute Critical Appraisal Tool for Qualitative Research. The extracted data were synthesised using meta-aggregation. Nine studies describing patients' experiences were included. The included studies only reflected experiences with wound dressings. Meta-aggregation of the extracted findings resulted in seven categories that were further synthesised into two synthesised findings: 'strategies to alleviate pain during dressing changes' and 'dressing construction and characteristics'. The synthesised findings illustrate that patients experience pain during dressing change and removal and employ various strategies to alleviate this pain. Patients experience pain and discomfort when dressings are changed or removed. Future research should focus on enhancing both routines and technologies, with a particular emphasis on advancing skin-friendly adhesives to reduce unwanted side effects. CRD42023457711.

Unlocking success: Full year quality and utilization metrics of payer-provider OMH partnership.

41 Background: For more than a decade, CMS and commercial payers have sought to engage provider organizations in value-based cancer care payment models (VBPMs). Success of VBPMs requires payer/provider alignment on quality/utilization measures indicative of high-value care and the efficiency of data exchange between providers and payers. The following describes several key metrics from the first full year 2022 of the Tennessee Oncology (TO) and BlueCross BlueShield of Tennessee (BCBST) Oncology Medical Home (OMH) partnership. Methods: TO and BCBST implemented reporting methodologies for a combination of practice-reported quality and utilization measures and payer claims-based measures: Patient experience, Pathway adherence, Distress screening / interventions, Admissions/1000 patients, ED visits/1000 patients, Imaging utilization, and Observation stays. Bi-weekly meetings between practice and payer were necessary to review quality/utilization measure reporting, coordinate overall program administration, and monitor member attribution for care management and performance-based payments. Results: TO/BCBST co-developed a VBPM that included bi-directional reporting of practice-reported quality and utilization measures and payer claims-based measures. Technical challenges in data sharing and reporting occurred frequently and required regular troubleshooting. Questions regarding trends in observed data arose frequently for both TO and BCBST and required regular discussions between clinical/operational leaders of payer and practice (Table). Conclusions: These data suggest that payers and community oncology practices can co-develop value-based payment models that yield transparency in quality and utilization data reporting, and observed differences in performance and cost-efficiency among different practices in a market. Payers can gain increased transparency in quality and cost-efficiency of cancer care for their members. Practices can leverage care management payments and performance-based payments to support care delivery and quality/utilization data reporting improvements. Provider and payer capabilities to execute transparent QM/UM reporting is a major challenge in implementing OMH programs. 2022 OMH results. Measure % higher or lower than benchmarks Admissions /k -7.0 ED visit /k -8.4 Imaging utilization + 9.4 Observation stays -10.0 Patient experience NA Pathway adherence NA Distress screening / interventions NA Hospice reporting NA NA = not applicable, no benchmark data available/measured; /k = per 1000 patients; negative = lower than benchmarks; positive = higher than benchmarks.

Methotrexate: Use in the Post Dobbs v. Jackson Era.

Methotrexate is one of the most frequently used medications for the treatment of rheumatic diseases. Although initially developed for use as chemotherapy for both solid and hematologic malignancies, it was used as early as the 1960s with success for rheumatoid arthritis (RA) and psoriatic arthritis, ultimately being approved by the US Food and Drug Administration for the treatment of RA in 1988. Beyond RA and psoriatic arthritis, methotrexate is used in the treatment of systemic lupus erythematosus, idiopathic inflammatory myopathies, and other inflammatory conditions. Methotrexate is cytotoxic to the trophoblast and has been used to treat both ectopic pregnancy and gestational trophoblastic neoplasia, leading to studies in the early 1990s that showed it was effective and safe for early abortion in combination with prostaglandin E1 analog misoprostol. Methotrexate is also a teratogen, causing serious birth defects in 6%-10% of patients taking it while pregnant. Additionally, women are more likely to be affected by both RA at SLE, as compared with males, thus worsening the burden of these adverse effects. Both methotrexate's history of use as an abortifacient and its teratogenic properties make its use more complicated in the current era of abortion policy in the United States following the Dobbs v. Jackson Women's Health Organization ruling. Recently published data suggest that this ruling has affected both provider perspectives and patient experiences as it relates to methotrexate use. In the post-Dobbs era, the role of the rheumatologist as it relates to patients' sexual and reproductive health is likely to expand.

Socioeconomic deprivation correlates with incomplete radiotherapy treatment in head and neck cancer.

There is a high burden of socioeconomic deprivation across Merseyside and, along with this, poorer cancer outcomes. The incidence of head and neck cancer squamous cell carcinoma (HNSCC) within this region is higher than the national average and there are often additional complexities to individual treatment pathways such as poor health literacy, lack of social support and transport options which can impact on adherence to prescribed treatments. AimThis work aims to understand the impact of deprivation on patients diagnosed with HNSCC undergoing chemoradiotherapy (CRT) or radiotherapy (RT) treatment through identifying barriers to adherence. MethodsPatients with HNSCC treated between June 2022-June 2023 were included and data collected through retrospective case note review. Approval was obtained from relevant NHS institution audit departments. Key examined variables were indices of multiple deprivation (IMD), unplanned admission rate, hospital transport use, social support network and provision of additional adhoc appointments during treatment courses. All were correlated with missed radiotherapy appointments. ResultsOut of 359 evaluable patients there were high levels of unplanned appointments with health professionals during CRT/RT (71% of those receiving CRT and 55% of those having RT). 11% (n=39) missed at least one radiotherapy appointment with the commonest reason being unplanned admission to hospital. Despite missed appointments, 25/39 patients completed treatment within prescribed window due to effective RT compensation strategies. On multivariate analysis, unplanned admission, hospital provided transport and crime deprivation quintiles (p=<0.001, p=0.007 and p=0.027 respectively) were found to significantly increase the chance of missed radiotherapy treatment appointments. ConclusionHigh levels of unplanned encounters with health care professionals are encouraging adherence to non-surgical HNSCC treatments. Formalising these adhoc appointments will provide an equitable, robust service. Undertaking hospital transport increases potential for missed treatment appointments. Gaining insight into patient experiences and investing in improved transport services are essential for maximising adherence.